Break Up the NHS

The NHS needs to be broken up. That's the first conclusion from the application of
Systems Thinking to the NHS.

Bottom-line: if the NHS were to fully adopt Systems Thinking
it wouldn't just save billions.

We'd also end up a lot more satisfied;
NHS people, patients, public.

Why bring this up now? Well it was recently announced that Britain's National Health Service is facing a huge budget short-fall and the BBC Today programme has been canvassing opinions on "where savings might be made".

But this is not quite the issue. It's more about how the NHS organisation can be more cost-effective - which is different, because it first looks at what the organisation's real aims are (and that of each part of it), and how well they're being accomplished.

So this means not piddling about with Systems Thinking (because the NHS does have courses on Systems Thinking, and it is used for trivial issues). It means adopting Systems Thinking into the culture and fabric of the NHS.

Systems Thinking isn't about computer systems; although these are included. It's about seeing everything as a system - in fact as a system within a system, with systems within it.

You are a system. A tree is a system. The Universe is a system. You and your laptop are a system. A football team is a system. The London Stock Exchange is a system. Every business & government organisation is a system. The NHS is a system.

This may all seem a bit academic at first, but Systems Thinking is practical and proven. It's a strategic yet structured way of looking at an organisation and each part of it, especially it's processes.

Here are ten Systems Thinking principles:
1. Everything is a system within a system, with systems within it.

2. Every system has a purpose, whether known or unknown.

3. Synthesis before analysis:
first determine the subject system as a whole in terms of it's boundaries, and then the external/contextual environment with which it inter-relates.

4. Every system must inter-relate effectively with its external/contextual environment environment to survive and remain viable.

5.a. The parts must intra-relate effectively for a system to inter-relate effectively with its external/contextual environment.
5b. Human organisations need effective dialogue and collaboration to inter-relate effectively with their external/contextual environments.

6. Synergy is where the whole is greater than the sum of the parts;
it results from the actualisation of ideal intra-relationships between the parts, for the respective purpose of each intra-relationship, within the overall purpose of the system.

7. Every part of a system is dependent on the other parts.

8. If each part of a system operates as efficiently as possible in itself, then the system as a whole will be ineffective.

9. First look to the idealised design based on the purpose of the system, regardless of practical constraints.

10. Every system has an optimum size beyond which it ceases to be viable, due (1) intra-relationship complexity and, (2) for organisations and projects in organisations, bureaucracy and loss of human identity with the system as a whole.

These principles have deep implications for the NHS, and indeed for any business or government organisation. There are a few organisations around the world whose leadership has made Systems Thinking happen in their organisations, and it has made a big difference.

So which of these principles is the NHS especially in need of recognising and/or adopting?

The most apparent is that the NHS should be broken up. It's the biggest per capita organisation in the world. True, the Chinese Army and the Indian Railways are bigger, but these two countries have much bigger populations.

If it's to be more cost-effective the NHS needs to be
broken up, de-centralised, and federalised.

P.S.
One last thing: Systems Thinking cannot happen unless the leadership of an organisation gets behind it.

At the same time, neither can it happen unless NHS people are also behind it. There is a way of doing this which, like Systems Thinking, is also practical and proven. It's called Genuine Action Learning (GAL), as originally developed by Professor Reg Revans, and successfully applied in many different contexts around the world.

It's a form of DIY change management, and it has been described by a very successful business leader as "The most powerful management tool ever identified."

But this blog article is already long enough, so Genuine Action Learning must await a future posting.